Liver transplantation is a well accepted therapy for cirrhosis, but not available to all patients in need because of a shortage of suitable organs. To address this problem, the field of living donor liver transplantation rapidly grew in the late 1990's, and concern about safety to liver segment donors, as well as the outcome in recipients quickly became a concern. The A2ALL consortium was developed to specifically study the safety and efficacy of this procedure for both donors and recipients, and has begun to answer some important concerns and research questions. However, several topics remain to be elucidated involving both donors and recipients. The proposed research will build on the foundation of the previous A2ALL database, as well as continue to recruit newly transplanted recipients and donors, and extend follow-up of previous study subjects. Critical questions which still need to be answered include the longer term effects on donors, both from a medical perspective as well as a psycho-social perspective. A more comprehensive review of donors at least five years out from the procedure will be completed, including a comparison to a control group of patients who had potential recipients but never went through the actual donation procedure. These findings will add to the question of safety of this procedure above and beyond the previous observations which were limited to the first 1-2 years after donation. Despite the early rapid growth of this procedure, it remains a relatively uncommonly applied therapy, at least compared to deceased donor liver transplantation. This study will also help to better define the ideal patient population that will truly benefit from the procedure, given the current liver allocation system and with newer knowledge that has been gained with the use of higher risk deceased donor grafts. In addition, the procedure of living donor transplantation has progressed over the last five years, and some newer techniques, including the use of left lobe grafts, will be examined and compared to results with standard right lobe grafts. Study of this newer cohort of transplanted patients will define the exact role of this procedure, and potentially lead to more widespread acceptance. PUBLIC HEALTH RELEVANCE: This study will help to answer questions and concerns about the safety and longer term side effects (5-10 year post procedure) of donating a portion of liver for living donor liver transplantation. It will also better define the best population of patients who will benefit from this type of transplant procedure. These are important public health concerns as the medical community attempts to define the role of living donor liver transplantation in the treament of liver disease.